Physician Assistants Seen As Means To Rein In Health Costs

ANZCA is monitoring closely a pilot programme in northern New Zealand where two surgical physician assistants - i.e. health professionals without medical degrees who take on tasks normally done by surgeons - have been employed.

Dr Vanessa Beavis, the Chair of the New Zealand National Committee, said that while physician assistants could make a useful contribution as anaesthesia assistants, ANZCA's main concern was for patient safety and the maintenance of high quality standards. She added "the mantra that it is cheap and efficient is patently untrue but is becoming part of the mythology".

ANZCA - and other medical colleges - also have major concerns that employing physician assistants will affect the training and clinical experience for medical students, junior doctors and their teachers if some of their current scope is removed.

The physician assistant trial, which follows similar trials last year in Queensland and South Australia, is being undertaken in New Zealand where health workforce demand is expected to double in 10 years and where spending on health is tracking up to four times faster than GDP.

In the US, where there are more than 75,000 physician assistants, a physician assistant's salary is about twice that of interns and resident doctors but far below that of a specialist. The cost of training a physician assistant is about a fifth that of a physician and PAs graduate in 26 months compared with nine years for doctors. . New opioid painkiller guidelines

There has been much controversy over the use of opioid-based painkillers (addiction being one of the side effects) and the Faculty of Pain Medicine last month approved a new position statement which can be used for doctors prescribing them to patients with chronic pain.

In his Dean's report, Dr David Jones, outlines the importance of the document, which is based on the latest and best evidence. An easy to use one-sheet guidance checklist for people such as GPs has been written as part of a package surrounding the statement.

It is widely acknowledged that the management of chronic pain is best achieved through multiple modes of therapeutic help (including physical and psychological therapy) and yet many GPs and other practitioners rely heavily on drugs to treat chronic pain, which affects one in five people. Anaesthesia's affect on thinking and memory under investigation

A team at St Vincent's Hospital in Melbourne is researching whether anaesthesia in elderly patients can lead to difficulties in thinking and memory - or even progression to dementia.

The researchers will test a group of 320 patients aged 55 years or older five years after they were measured for cognitive decline following heart surgery in a previous study by Associate Professor Brendan Silbert.

In another study, Associate Professor Silbert and his colleagues are examining thinking and memory after hip replacement surgery. In particular, the researchers are measuring the number of small particles that find their way to the brain during an operation. Recent evidence suggests these may play a part in diminishing brain function and if this is the case, preventative measures may be developed. Short course essential in relieving pain in PNG and the Pacific

Pain is a common problem in developing countries. Trauma pain, especially from car accidents, is an increasing problem, post-operative pain is prevalent, and the World Health Organization has indicated that 80% of new cases of cancer occur in poorer parts of the world. An estimated 75% of these cancer patients will experience moderate to severe pain during the course of their illness. Yet, according to anaesthetist Dr Wayne Morriss from Christchurch Hospital in New Zealand and pain management specialist Dr Roger Goucke from Sir Charles Gairdner Hospital in Perth, pain is often poorly managed in these countries. Essential Pain Management (EPM) is an ANZCA-supported short course for doctors and nurses in Papua New Guinea and the Pacific Islands which is having a major impact on pain recognition and treatment. The EPM course, which emphasises low cost management strategies and how quality of life can often be markedly improved with very simple treatments, can be followed by an instructor workshop so that participants can take the program back to their own hospitals.

The benefits of eHealth: an anaesthetist's experiences in Japan

As Australia moves towards an eHealth system, Dr Pat Mackay tells of her recent first-hand experiences in a high-tech provincial Japanese university hospital 300km from Tokyo. Dr Mackay, OAM, an ANZCA Quality and Safety Committee member and former head of anaesthesia at the Royal Melbourne Hospital, was admitted to the Niigata University Hospital after experiencing a potentially fatal blood clot in her lung while emerging from her plane. She found the hospital tranquil and almost luxurious (bathrooms had tilting chairs and basins for wheel-chair bound patients wanting to wash their hair). She found that rather than depersonalising care, the sophisticated hospital-wide electronic patient systems allowed hospital staff more time for personal interaction. During her two-week hospital stay, Dr Mackay noted marked differences between the hospital and those in Australia. There was a more relaxed demarcation of duties (doctors and nurses often helped orderlies transfer patients in wheelchairs), a strict adherence to appointment times that meant no waiting in corridors for tests, and bar coded wristbands allowed for more efficient and safe electronic management of drugs. Noteworthy was the large central station in each ward that accommodated a bank of computers necessary for the entire electronic management of patient care.

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